{"id":10978,"date":"2018-01-23T09:53:12","date_gmt":"2018-01-23T09:53:12","guid":{"rendered":"https:\/\/magazines.uthscsa.edu\/mission\/?p=10978"},"modified":"2018-02-22T18:33:06","modified_gmt":"2018-02-22T18:33:06","slug":"dear-doctor-get-well-soon","status":"publish","type":"post","link":"https:\/\/magazines.uthscsa.edu\/mission-old\/dear-doctor-get-well-soon\/","title":{"rendered":"Dear doctor, get well soon"},"content":{"rendered":"

By<\/em> Joe Michael Feist<\/strong><\/p>\n

Stacy, now a practicing physician, was a resident at UT Health San Antonio when her world grew dark and frightful, shaking her as it spiraled downward. \u201cEverything was painted black. Everything was negative. I didn\u2019t want to do this anymore. I didn\u2019t want to do anything,\u201d said Stacy (not her real name), describing her descent into clinical depression. \u201cI was changing from \u2018This is great, I love this, I enjoy seeing patients,\u2019 to \u2018Why am I waking up at 4 a.m. to see this [patient] who\u2019s just going to complain, and they don\u2019t even know what I\u2019m going through and they don\u2019t care,\u2019\u201d she said. \u201cI started seeing patients as a burden instead of seeing them as people I became a doctor to help.\u201d<\/p>\n

She was depressed, anxious, moody, had low self-esteem and seriously questioned her choices and abilities. She constantly told herself she wasn\u2019t smart enough, that she was an impostor. Her dream of becoming a doctor became a recurring nightmare. And worst of all, Stacy added, was the feeling that she couldn\u2019t tell a soul what she was going through. \u201cNo one can find out,\u201d she thought. \u201cIf anyone knew, that would be the end of my career.\u201d<\/p>\n

Stacy felt totally alone, but in fact was far from it. In the past few years, a full-blown crisis has emerged among residents and practicing physicians suffering from burnout, depression, substance abuse and suicide.<\/p>\n

The numbers alone are staggering.<\/p>\n

\u2022 An estimated 56 percent of all physicians are burned out, reaching close to 70 percent in some specialties.<\/p>\n

\u2022 One out of three physicians is suffering from clinical depression.<\/p>\n

\u2022 Seven percent of physicians are actively abusing substances, whether illegal substances, alcohol or prescription meds.<\/p>\n

\u2022 Seven to nine percent of physicians have had suicidal ideations in the past two months.<\/p>\n

\u2022 An estimated 400 doctors commit suicide each year, or the equivalent of two entire classes of medical students at UT Health San Antonio. Physicians are far more likely to commit suicide than the general population. And female doctors are three times as likely to kill themselves as male doctors.<\/p>\n

The bleak story told by the numbers means \u201cthe practice of medicine in this country is faced with a momentous challenge, perhaps even an existential crisis,\u201d said Jon Courand, M.D., vice chair of education and training for pediatric residents and fellows, and chair of the Wellness and Resident Worklife Standing Committee at UT Health San Antonio.<\/p>\n

Computers are not people<\/i><\/p>\n

Dr. Courand, who has reviewed the issue extensively, pointed to several factors commonly cited as root causes of physician burnout, depression and suicide. Among these are administrative burdens, intrusion of technology, staggering patient volume and the intricacy of patient care.<\/p>\n

\u201cThe workloads are increasing, but more than just the workload, the complexity of the patients, the acuity,\u201d Dr. Courand said. \u201cThey\u2019re more complex, they\u2019re sicker and there are more of them. We\u2019re putting a greater workload on our physicians.\u201d<\/p>\n

Another huge source of stress is electronic medical records (EMR), he added.<\/p>\n

\u201cThe issue is it removes us from the patient,\u201d Dr. Courand said. \u201cThere\u2019s an interesting study that shows if a resident has, for example, eight patients, on average they spend about seven minutes with each patient. For those eight patients they spend less than an hour a day physically talking to people, but another four-plus hours on the EMR.<\/p>\n

\u201cMy personal belief is we went into medicine to do one thing, and that is to take care of people, but increasingly we\u2019re taking care of a computer screen and not people. I think that leads to disillusionment, burnout and depression,\u201d he said. \u201cThere are a lot of people, I think, who believe the same thing.\u201d<\/p>\n

Years ago, most doctors worked alone in a private practice, were paid in cash, and dealt with few regulations and technology. Today, doctors across the board are under extraordinary pressure to make money, to meet \u201crelative value unit goals,\u201d Dr. Courand said, adding that faculty physicians in academic health institutions are not immune.<\/p>\n

Because of \u201cpaperwork\u201d and financial concerns, most physicians in the outpatient world spend only about 10 minutes with a patient, Dr. Courand said. \u201cIt used to be 20 minutes, then it was 15, now it\u2019s 10.\u201d<\/p>\n

Straightforward cases, such as an ear infection, may only get five minutes of the physician\u2019s time. \u201cIt\u2019s just move \u2019em in, move \u2019em out. Patients feel that. They don\u2019t feel that there\u2019s that bond,\u201d he said.<\/p>\n

The complexity of medicine, the demands of technology and the financial pressures all affect the way doctors view their role and their self-worth. Thus the levels of burnout, depression and suicide.<\/p>\n

\u201cReal burnout is a low sense of personal accomplishment, emotional exhaustion and\u00a0depersonalization,\u201d Dr. Courand said. \u201cDepersonalization is saying, I have this patient in front of me who\u2019s suffering and may die, and I couldn\u2019t care less. I feel nothing for this person. That\u2019s scary. There\u2019s a large percentage of physicians in the country who right now are either emotionally exhausted or depersonalized.\u201d<\/p>\n

High stress, high stakes, real expectations<\/i><\/p>\n

For faculty and administrators at an academic health institution, one obvious way to prevent physician depression and suicide is to face the issue head on, openly and honestly, with today\u2019s residents and students. Knowledge, and the early identification of stressors, is the key to preventing tomorrow\u2019s depression and suicide, educators believe.<\/p>\n

To that end, UT Health San Antonio this year hired two Ph.D. psychologists to focus on wellness with its 700 to 800 residents and fellows. The psychologists will run an interactive screening program that will send surveys to every resident and fellow asking questions about depression, suicidal ideation, burnout, substance abuse, even eating disorders.<\/p>\n

\u201cIt\u2019s a voluntary, completely anonymous, encrypted program that allows residents to enter into a counseling relationship with one of our providers, either anonymously through the computer or face to face,\u201d Dr. Courand said. \u201cAnd the psychologists will be promoting 45 separate wellness activities designed to promote resilience,\u201d including everything from healthy eating to mindfulness training to quiet areas for meditation.<\/p>\n

And it\u2019s not just practicing physicians and residents who are dealing with these issues. Medical school students are susceptible to the same stressors.<\/p>\n

\u201cIt\u2019s a high-stress field,\u201d said Thomas Matthews, M.D., clinical professor\/psychiatry who spent more than nine years as associate dean for student affairs in the Joe R. & Teresa Lozano Long School of Medicine. \u201cEven to get into medical school, you\u2019re expected to do research, volunteer, keep your grades up. There\u2019s so much you have to do to get in. What you\u2019re doing is taking people who are Type A personalities or high-stress people anyway, and you\u2019re piling things on. They come in to med school and they\u2019re already very stressed.\u201d<\/p>\n

Dr. Matthews, along with Kristy Kosub, M.D., professor and director of student education for the Department of Medicine, have long worked on wellness issues in the medical school.<\/p>\n

Just recently, Dr. Kosub said, \u201cWe have as a school really started to ramp up how we\u2019re going to expose our students to the reality that this [burnout and depression] exists. And really making a concerted effort to make sure we\u2019re addressing it all four years.\u201d<\/p>\n

Both Drs. Matthews and Kosub pointed to Veritas, the school\u2019s student advisory group with both faculty-student and peer-to-peer advising and counseling, as a way of talking about burnout and stress.<\/p>\n

\u201cIt\u2019s a way for students, within their Veritas group and faculty advisers, to engage in regular meetings with various topics like burnout, so that they don\u2019t have that feeling of isolation as they go through medical school,\u201d Dr. Kosub said.<\/p>\n

Other avenues toward self-awareness for students include the opportunities offered by the Center for Medical Humanities & Ethics, she said. Through electives, community service-learning projects and speakers, the center \u201cprovides the crucial element of humanism, to remind people it\u2019s not just all about one\u2019s medical knowledge, it\u2019s taking care of people and taking care of yourself.\u201d<\/p>\n

There are many more wellness activities, lectures, social gatherings, informal talks and direct mentoring as well.<\/p>\n

Doctors are people, too<\/i><\/p>\n

What\u2019s critical, faculty agree, is creating a positive environment where people feel comfortable enough to talk about stress, depression, feelings of inadequacy or being overwhelmed. And that applies not just to students, said Dr. Kosub.<\/p>\n

\u201cWe don\u2019t have a wellness program for existing faculty and staff,\u201d she said. \u201cThat\u2019s where we\u2019re falling down. I\u2019m hopeful that the Long School of Medicine and the university as a whole will start to build on that. The key is to make this part of the culture of the school, the residency program, the entire institution.\u201d<\/p>\n

At an academic health institution, Dr. Kosub added, faculty need to role-model healthy lifestyles. She noted that Stanford Medicine, in a first for a U.S. academic medical center, just hired a chief wellness officer charged with countering physician burnout and improving physicians\u2019 sense of fulfillment and well-being.<\/p>\n

The broader cultural issues need to be acknowledged as well.<\/p>\n

\u201cThe stigma surrounding mental health issues and depression is rampant in all professions, including among doctors and health care workers,\u201d said Dr. Kosub. \u201cAnd it\u2019s not just doctors. It\u2019s a human quality of not wanting to disappoint people, not wanting to show weakness.\u201d<\/p>\n

As for Stacy, the former resident who walked on the edge of depression and even suicide, she found the strength and the trust in the institution that saved her.<\/p>\n

\u201cFinally,\u201d she said, \u201cI went to the program director and said, \u2018I need to figure this out because I don\u2019t want to get to the point where I can\u2019t work anymore. It\u2019s bad enough that I have to talk to you about it.\u2019 And my program director actually smiled. And it was like, you\u2019re not the first and you won\u2019t be the last.\u201d<\/p>\n

Stacy began seeing a psychiatrist \u201cwho taught me a lot of tools to be able to cope with those negative thoughts and emotions.\u201d<\/p>\n

She began paying more attention to her own health and well-being and became more aware of stress triggers. She pulled through.<\/p>\n

The bottom line, said Dr. Matthews, is that \u201cdoctors are people, too. When it comes down to the core of each of us, we\u2019re all just a person. And sometimes life can overwhelm each of us, no matter how smart you are.<\/p>\n

\u201cWhen you\u2019re drifting in a storm, you really need someone to throw you that lifeline.\u201d<\/p>\n

\n

\"\"UT System addresses well-being of physicians<\/b><\/h2>\n

The public health care crisis created by physician burnout and depression is being addressed by The University of Texas System, of which UT Health San Antonio is a component.<\/p>\n

\u201cAs the employer of thousands of physicians, University of Texas institutions have a great stake in assuring that they can thrive despite the many stresses and pressures of their work environment,\u201d said Ray Greenberg, M.D., Ph.D., the UT System\u2019s executive vice chancellor of health affairs. \u201cThe UT System aspires to be a leader in developing and implementing strategies to support the well-being of our caregivers.”<\/p>\n

In September, the UT System sponsored a symposium at The University of Texas MD Anderson Cancer Center in Houston that brought national leaders to discuss the causes, consequences and solutions for physician burnout in academic health settings. A multi-pronged plan includes conducting a systemwide assessment of the problem, creating focus groups and recommending solutions at the clinical, departmental, institutional and system level.<\/p>\n

Chancellor William H. McRaven said reducing physician burnout needs to be a priority because of its broad repercussions.<\/p>\n

\u201cI think this is a major, major issue \u2026 and we have to aggressively address it,\u201d McRaven told the UT System Regents recently. \u201cWe can be a national leader in this and we should.\u201d<\/p>\n

 <\/p>\n

\u00a0<\/span>Students, residents, fellows, faculty and staff:<\/strong> If you need mental health assistance, please contact the Employee Health & Wellness Clinic<\/a> or\u00a0<\/a>the Student Health & Wellness Center<\/a>. Assistance is also available through the UT Employee Assistance Program<\/a>. Click here<\/a> for more information.<\/div>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

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